Authors' objectives:

This aim of this report was to assess the effectiveness of exceeding the recommended total dose of follicle stimulating hormone (FSH), that is 3000 IU, in women labelled as poor responders undergoing ovulation stimulation as part of an Assisted Reproduction Technology (ART) program.

Authors' recommendations: - There were no published clinical trials designed to study the effectiveness of administering fixed total dose >3000 IU of recombinant human FSH (rhFSH) or urinary-derived FSH for ovulation stimulation of poor responders in assisted reproduction programs. - There was no consistent definition of a poor responder. The definition was based on previous ovarian stimulation cycles but varied among parameters: measurements of serum estradiol, number and size of follicles, FSH dosage required to stimulate follicular growth. - Two small randomized controlled trials, one of recombinant FSH and one urinary FSH, found no improvement in treatment outcomes when administering high doses to poor responders. Rombauts et al (1998) studied the effectiveness among 40 poor responders of an ovulation induction protocol commenced in the luteal phase. Only some study patients were administered as much as 3300 IU rhFSH but study results did not address the dose-response advantages for this dosage level. The authors concluded that based on number of oocytes collected, there was no advantage to the longer, higher dose protocol. Similarly, in a randomized study of doubling the dose of hMG given to 46 low responders, no differences were found in the number of follicles of increased size, number of oocytes retrieved and pregnancy rates compared to the lower dose group (van Hoof et al 1993). - There were three other studies in which poor responders were administered >3000 total dose of a urinary-derived follicle stimulating hormone (uFSH). Two retrospective studies found no improvement in outcomes (number of follicles and/or oocyte retrieval rate and/or pregnancy rate) with higher doses. A prospective study recommended a protocol which included high-dose FSH but this study provided no comparison data to substantiate these findings.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.med.monash.edu.au/healthservices/cce/evidence/

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Centre for Clinical Effectiveness

Contact Address: Monash Institute of Health Services Research, Block E, Monash Medical Centre, Locked Bag 29, Clayton, Victoria 3168, Australia. Tel: +61 3 9594 7505; Fax: +61 3 9594 7552.

Contact Name: cce@med.monash.edu.au.

Contact Email: cce@med.monash.edu.au.

Copyright: Centre for Clinical Effectiveness (CCE)